Arm and Shoulder Joint

Question 1

_____ for attachment of the long head of the biceps

Answer 1

Supraglenoid tubercle

Question 2

_______ for attachment of the long head of the triceps

Answer 2

Infraglenoid tubercle

Question 3

Distal humerus has two articular surfaces:

Answer 3

1. Capitulum (lateral) for articulation with the head of the radius
2. Trochlea (medial) for articulation with the ulna

Question 4

______ receives the coronoid process of ulna during flexion of elbow

Answer 4

Coronoid fossa

Question 5

_____ receives radial head during flexion of elbow

Answer 5

Radial fossa

Question 6

_______ located on the posterior surface for passage of the radial nerve and the deep brachial artery

Answer 6

Radial groove

Question 7

_______ on posterior aspect of the medial epicondyle for the passage of the ulnar nerve (common site for ulnar nerve impingement)

Answer 7

Ulnar groove

Question 8

_____ are incorporated into these veins at regular intervals to increase the efficiency of venous return

Answer 8

Valves

Question 9

_____ are located within the subcutaneous tissues (easily visible)

Answer 9

Superficial veins

Question 10

Cephalic Vein- ascends the anterior lateral aspect of the arm- courses through the _____ where it joins the axillary vein (a deep vein)

Answer 10

Deltopectoral Triangle

Question 11

_____ ascends the anterior medial aspect of arm- then pierces the deep (brachial) fascia in the middle of arm to join the brachial veins (which are deep veins)

Answer 11

Basilic vein-

Question 12

Both superficial veins communicate via the _____ anterior to the elbow- a common site for phlebotomy

Answer 12

median cubital vein

Question 13

Sheath of deep fascia that encloses the arm like a sleeve- continuous from the deltoid, pectoral, and axillary fascia proximally

Answer 13

Brachial Fascia

Question 14

The brachial fascia continues distally into the forearm as _____

Answer 14

antebrachial fascia

Question 15

Strong septa arise from this brachial fascia and attach to the shaft of the humerus and …

Answer 15

These medial and lateral intermuscular septa divide the arm into an anterior (flexor) and posterior (extensor) compartments

These compartments share muscles with similar function and innervation

Question 16

muscles of the anterior arm compartment and what they are innervated by

Answer 16

biceps, brachialis, coracobrachialisis; muscuolocutanous nerve

Question 17

The Biceps Brachii orginates from two heads

Answer 17

1. short head from the coracoid process of scapula
2. long head from the supraglenoid tubercle of scapula (tendon courses in the intertubercular sulcus or bicpital groove)

Question 18

The biceps brachii inserts into the _____ and the ______ via the bicipital aponeurosis

Answer 18

proximal radius (radial tuberosity); antebrachial fascia

Question 19

Bicep muscles crosses two joints (shoulder and elbow)…hence it acts on both joints

Answer 19

1. Flexes the shoulder joint
2. Powerful supinator of the forearm but also a flexor of forearm (elbow joint)

Question 20

Ruptured Biceps

Answer 20

Rupture of the long head of the biceps generally occurs due to “wear and tear” or prolonged tendonitis (baseball pitchers, weight lifters) or chronic arthritis (i.e. rheumatoid arthritis) within the joint

Tendon commonly tears from the supraglenoid tubercle of the scapula (audible “snap or pop” can often be heard)

Detached muscle belly forms a prominent “ball” near the center of the anterior arm

Hence the description… “Popeye deformity”

Question 21

Located deep to the Biceps

Originates from distal ½ of the humerus

nInserts into the proximal ulna (tuberosity of the ulna)

Prime flexor of the forearm (elbow)

Innervated by (C5 & C6) of the musculocutaneous nerve

Answer 21

Brachialis

Question 22

Coracobrachialis orginates from the

Answer 22

ncoracoid process

Question 23

Coracobarchiallis inserts in the

Answer 23

middle 1/3rd of the humerus

Question 24

coracobrachiallis motion

Answer 24

nBoth a flexor and adductor of the arm

Question 25

Musculocutaneous Nerve arises from ___ and innervates **anterior/posterior** compartments of the anterior arm and continues as the \_\_\_\_

Answer 25

Arises from the lateral cord of the brachial plexus; anterior; Continues as the **lateral cutaneous nerve** of the forearm (aka the lateral antebrachial cutaneous nerve)

Question 26

Subclavian artery passes the 1st rib it becomes the \_\_\_\_\_

Answer 26

axillary artery

Question 27

Axillary traverses the teres major muscles it becomes the \_\_\_\_

Answer 27

brachial artery

Question 28

The axillary artery which turns into the brachial artery accompanies the ___ nerve

Answer 28

median nerve

Question 29

It is clinically significant in that the brachial artery can sometimes be ligated (tied-off) just above the elbow (i.e. to control heavy post traumatic bleeding) because of the \_\_\_\_\_\_\_

Answer 29

extensive collateral branches can continue to perfuse the forearm and hand

Question 30

\_\_\_\_\_ artery -largest branch and accompanies the radial nerve through the radial groove

Answer 30

Deep (Profunda) Brachial Artery

Question 31

Superior Ulnar Collateral Artery- accompanies the _____ nerve posterior to medial epicondyle of humerus

Answer 31

ulnar

Question 32

Collateral vessels provide also important anastomoses (alternate route for blood flow) around the elbow joint during **flexion/extension**

Answer 32

during limb flexion

Question 33

only one muscle located in posterior compartment of the arm

Answer 33

Triceps Brachii

Question 34

the three heads of the triceps brachii; and which ones in respect to radial groove

Answer 34

1.Long head originates from the infraglenoid tubercle of scapula **2.Lateral head** originates from the posterior surface of humerus **superior** to radial groove **3.Medial head** originates from the posterior surface of humerus **inferior** to radial groove

Question 35

all three heads of the tricep brachii insert into the

Answer 35

olecranon process of ulna

Question 36

motion of the tricep brachii

Answer 36

Prime extensor of the forearm

Question 37

innervation of tricep brachii

Answer 37

Innervated by (C6, **C7** & C8) of the radial nerve

Question 38

\_\_\_\_\_\_\_\_ nerve courses through the posterior compartment in the **radial groove** beside the **profunda (deep) brachial artery (triangular interval)**

Answer 38

radial nerve

Question 39

Radial nerve then gives rise to the __________ of the **arm and forearm** which supply sensation to the skin along the posterior (dorsal) aspect of the upper limb

Answer 39

**Posterior cutaneous nerves**

Question 40

Mid Shaft Humeral Fractures

Answer 40

Frequently result from direct trauma (auto accidents) Proximal fragment often displaces laterally due to pull of the deltoid muscle Radial nerve can be stretched or transected along the radial groove leading to permanent damage and loss of function As you will soon learn, the radial nerve ALSO innervates all the muscles that “extend” the wrist…patients typically present with wrist drop due to loss of innervation of the extensors muscles of the forearm and hand “Saturday Night Palsy”…compression of radial nerve against the humerus can cause a temporary wrist drop

Question 41

Surgical Neck Fractures

Answer 41

nSurgical neck located just distal to the tuberosities nThese fractures an be associated with injure to the axillary nerve nAxillary nerve damage can result in paralysis and atrophy of deltoid-loss of rounded shoulder contour

Question 42

\_\_\_\_\_\_ vessels drain lymph fluid from the skin and subcutaneous tissues and converge to follow the cephalic and basilic veins (superficial veins)

Answer 42

Superficial lymphatic

Question 43

\_\_\_\_\_\_\_ drain lymph fluid from joints, muscles, and bones and accompany _______ veins

Answer 43

Deep lymphatic vessels; deep

Question 44

Lymph from these nodes then joins the venous system via the _______ or the _________ which both convey the lymph fluid into the venous system (via the subclavian veins)

Answer 44

right lymphatic duct (right upper limb); thoracic duct (left upper limb)

Question 45

Glenohumeral Joint

Answer 45

nBall-and-socket type synovial joint nExtremely mobile joint-but relatively unstable nLarge humeral head articulates with the small, shallow glenoid cavity

Question 46

\_\_\_\_\_\_ a fibrocartilagenous “ring” that surrounds and deepens the glenoid cavity- providing greater stability

Answer 46

Glenoid Labrum

Question 47

\_\_\_\_\_\_\_ helps stabilize and hold the humeral head within glenoid cavity

Answer 47

Musculotendinous Rotator Cuff

Question 48

\_\_\_\_\_\_\_\_\_\_\_ holds long head of bicep tendon in the bicipital groove

Answer 48

Transverse humeral ligament

Question 49

\_\_\_\_\_\_\_ lines the inside of the joint capsule and reflects/surrounds the tendon of the long head of the biceps

Answer 49

Synovial membrane

Question 50

Shoulder Dislocations

Answer 50

The glenohumeral joint is extremely mobile- providing a wide range of movements at the expense of stability For this reason- it is the most frequently dislocated major joint in the body Structurally- the inferior aspect of the joint is the weakest Dislocations due to trauma are most common in the anterior-inferior direction…often tearing the labrum and anterior joint capsule/subscapularis tenson Humeral head often ends up beneath the coracoid process (sub-coracoid) Once dislocated, the joint is susceptible to frequent dislocations

Question 51

Other cutaneous nerves arise directly from the major branches of the plexus:

Answer 51

Lateral cutaneous nerve of the forearm (from the musculocutaneous nerve) Superior lateral cutaneous nerve (from the axillary nerve)

Question 52

Some of these “cutaneous nerves” arise directly from the medial cord of the plexus:

Answer 52

Medial cutaneous nerve of the arm Medial cutaneous nerve of the forearm

Question 53

nSimilarly, most of the cutaneous nerves on the posterior aspect of the upper limb arise from the radial nerve:

Answer 53

nPosterior cutaneous nerve of the arm nPosterior cutaneous nerve of the forearm nSuperficial branch of the radial nerve

Question 54

\_\_\_ are relatively common and tend to occur in an anterior-inferior direction

Answer 54

nShoulder dislocations

Question 55

nShoulder dislocations can tear/damage the _______ which results in a high incidence of recurrence

Answer 55

glenoid labrum

Question 56

Mid-shaft fractures of the humerus can injure the ______ resulting in loss of function (wrist drop)

Answer 56

radial nerve

Question 57

\_\_\_\_\_\_ is susceptible to tendonitis and subsequent tears due to its course thru the bicipital groove and intra-articular position within the shoulder

Answer 57

Long head of the bicep

Question 58

Beatrice Long, a 77 year-old female with a 20 year history of rheumatoid arthritis presents to the orthopedic clinic. She has been on steroid medication for ~ 10 years to help control chronic arthritis in her joints. 3 months ago, she had a cortisone injection into her right shoulder to help alleviate serve pain and inflammation. Beatrice explains to her orthopedic physician that while attempting to lift a heavy box yesterday, she felt something “give-way” in her right shoulder area. She also complains that now she feels a “lump’ in the middle of her upper arm. Which of the following is likely to have occurred? A. Torn acromioclavicular ligament B. Torn rotator cuff muscle C. Torn deltoid muscle D. Torn biceps muscle

Answer 58

D. Torn biceps muscle

Question 59

Whalen, a 30 year-old man is inebriated and falls asleep on a park bench on Franklin Street in Chapel Hill. When he awakes, he realizes he had been sleeping there for nearly 6 hours. Which of the following nerves was most likely compressed/damaged with his arm lying against the hard wooden bench for 6 hours? Think…Pair…and Share A.Axillary B.Musculocutaneous C.Radial D.Median E.Ulnar

Answer 59

C.Radial

Question 60

Imaging: Physician orders X-rays to evaluate osseous and/or ligamentous damage Diagnosis: Traumatic left subcoracoid dislocation of the glenohumeral joint Treatment: Under sedation, the dislocation is reduced (X-rays confirm), Sheryl is placed in a splint for several weeks followed by rehabilitation physical therapy Sheryl returns 3 months post reduction. She denies any pain in the shoulder joint… but she mentions that she is still experiencing some tingling sensations along her left forearm. Based on these new symptoms, which nerve could she have damaged? Think…Pair..and Share A.Axillary B.Radial C.Long Thoracic D.Musculocutaneous E.Suprascapular

Answer 60

D.Musculocutaneous

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radial nerve

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Surgical Neck Fractures

Question 76

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Mid Shaft Humeral Fractures

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